Abstract
In general, the results of surgery on anterior communicating aneurysms (ACom AN) is worse than that on internal carotid and middle cerebral aneurysms (IC and MC AN), because of technical difficulty due to the deep location and complex anatomical relationships. Some attempts were made in our hospital to reduce the technical difficulty and improve the surgical results of operation for ACom AN. In this paper, the effect of these attempts was analysed in 208 cases. The timing of the operation and clinical grade were as followes: within 3 days: 67 cases, 4-14 days: 41 cases, over 14 days: 100 cases, I-II: 154 cases, III: 38 cases, IV-V: 15 cases. The operation was carried out by the unilateral pterional approach in all cases. In each case, the side of the approach was determined by angiographic findings except for cases with additional AN and significant hematoma. Craniotomy was performed at the side of the dominant Al in cases where the AN projected forward-downward. In the other cases, the operation was carried out at the side of the deep-seated A2. Use of a temporary clip for a short time and partial removal of gyrus rectus were positively carried out.
Craniotomy was performed at the right side in 93 cases (45%) and at the left side in 115 cases (55%). A temporary clip was used in 106 cases (51%) and was significantly frequent in grade II, III cases and in cases operated on within 14 days after SAH. Partial removal of the gyrus rectus was performed in 61 cases (29%) and was significantly frequent in cases where the AN projected upward, grade III, IV cases and cases operated on within 14 days after SAH. Clipping of the AN was performed in all cases. Operatve mortality plus morbidity rate was as follow; I-II: 7%, III: 20%, IV-V: 25%. The side of the craniotomy, use of a temporary clip and partial removal of the gyrus rectus caused no significant difference in these rates. The results in cases with AN were almost the same as the results with IC and MC AN. From these results, we can conclude that the side of the craniotomy should be determined by angiographic findings in each case, and use of a temporary clip and partial removal of the gyrus rectus should be carried out actively at the time of the operation for ACom AN.
